Saul Robbins, a New York photographer, has photographed therapists’ chairs in a series called “Initial Intake,”

By PENELOPE GREEN

Published: March 6, 2008

ANN LOFTIN could write a textbook on the nuances of modern psychotherapeutic methods — and the personality types of their practitioners — based on the home office décor of the therapists who have treated her. There was the strict Freudian whose couch was covered in plastic and who barely spoke, though every once in a while a phrase like “mother’s milk” might have slipped out. Another’s office featured phallic African statuary and pictures of a young wife, who was herself always audible somewhere in the background. A licensed clinical social worker had lots of comfy, overstuffed furniture and encouraged patients to sit anywhere (sessions ended in long hugs that suggested much countertransference). Her last analyst, with whom she spent a fruitful decade, did not see patients in his home, but in an office building, and his room there held nothing more than two nondescript leather chairs, a bookcase lined with medical texts and a table holding a box of tissues.

“I’ve seen the good, the bad and the ugly,” said Ms. Loftin, a 53-year-old freelance writer from Lakeville, Conn., with 20 years of therapy behind her. Like many patients, Ms. Loftin learned long ago that a therapist’s office — particularly a home office — and the stuff that’s in it can be freighted with more revelations than Sunday morning in a Baptist church.

Therapists have been working out of their homes ever since psychoanalysis was invented, but recently the meaning and message of that setting have come under particular scrutiny. As viewers of the HBO series “In Treatment” will attest, a home office can be a very problematic space. In an early episode of the series, starring Gabriel Byrne as a therapist named Paul Weston, Laura, a repellently narcissistic patient with a bad case of erotic transference (that’s shrink talk for having a crush on your doctor), nearly claws down the door that separates Weston’s office from his house in an attempt to get to a bathroom (the bathroom in his office is broken). Agitation on both sides ensues. For the writers of “In Treatment,” Weston’s office becomes a metaphor for how the boundaries are breaking down between his work and his personal life. But even in the real world, therapists are increasingly aware that their office space can have a profound impact on their patients.

Last year, an article in Psychoanalytic Psychology, a journal of the American Psychological Association, created a ruckus by questioning the ethical considerations surrounding therapists’ home offices. Its author, Karen J. Maroda, an analyst and the former ethics chair of the division of psychoanalysis of the American Psychological Association, wrote that the sights and smells of the doctor’s home were “keyholes” into his or her life that could be overly stimulating or overwhelming. “Oedipal material, for instance, should arise when a patient is ready to face it,” she wrote, “not when he or she bumps into the analyst’s spouse in the driveway.”

Dr. Maroda remembered her own experience as a young analyst and patient being seen in her therapist’s tony home, replete with family members and an ample household staff. “I didn’t realize the negative effect on me as a patient until years later when I had more objectivity,” she said last week.

“The session was on Saturday mornings and so I’d see her son, the glaring teenager, who was obviously resenting her time away from him. I felt guilty. I felt angry. They were wealthy; I was just starting out. The first session, the door was opened by a maid. For someone who didn’t come from money it was very intimidating.” At the same time, it was a deeply nurturing experience, she said, adding this caution: “Just because it feels good in the moment doesn’t mean that it’s ultimately therapeutic.”

What she hadn’t bargained on, continued Dr. Maroda, was how angry the response would be to her article, expressed in follow-up pieces published in the journal, as well as affronted comments to its editor and to her. “I had someone say that I was conducting a witch hunt,” she said. Clearly, Dr. Maroda had touched the analytic community right where it lived. At home.

TWO Sundays ago, Lewis Aron, director of New York University’s postdoctoral program in psychotherapy and psychoanalysis, organized a salon for his peers. The topic? “In Treatment.” Two hundred analysts showed up. “It went like this,” said Dr. Aron. “Someone would stand up and say, ‘Hi, my name is Judy X and I’m addicted to ‘In Treatment,’ and then everybody would say, ‘Hi, Judy!’ ” For two hours, the analysts discussed the various mistakes Weston makes regarding boundary issues, and one analyst broached the idea that the placement of his office in his home was the cause of his many transgressions.

“Someone brought up Maroda’s article,” said Dr. Aron. “He didn’t agree with her. I don’t either. I think there is always a dialectic tension between the personal and the professional and we lose a lot by making the setting too clinical. There is something engaging in seeing the therapist has a real life, and is a real person.”

Few therapists today would contend that it’s possible or even desirable to present oneself as a true blank slate, with an office and treatment style utterly free from personal influence. And so the conversation now centers on degrees of influence and revelation: is a family photograph too much? What about the family dog?

Consider the experience of Betsy Israel, a Manhattan author, as a case of rather too much revelation. When she was in her 20’s, Ms. Israel, now 49, was treated by an elderly female analyst who was “so strict, so doctrinaire it was like being analyzed by Anna Freud,” she said. “I had a brilliant transference: she was my mother, and for two years we were trying to get through talking about sex and denial.”

One day, Ms. Israel was waiting for her session in the long hall that led to the office, which was in a cavernous apartment on the Upper West Side. She began to focus on the faded, 50s-era nude watercolors that lined the hall and realized with horror that the subject of those nudes was her doctor.

“She was a very proper lady in tweeds, not a naked person at all, if you know what I mean,” said Ms. Israel with an audible shudder. “I never brought it up. I felt like that was a failure on my part, but it also began the process of turning away” from treatment, she said, which perhaps was not such a bad thing. Ms. Israel speculated that the nudes’ placement was intentional, possibly to “raise the stakes” for certain patients. But what the child psychologist who treated Ms. Israel’s young daughter after 9/11 intended by laying out a book of Robert Mapplethorpe nudes in the waiting room was beyond her reasoning. “I couldn’t make sense of it,” she said.

The presence of a pet in a therapist’s office can be similarly confounding. Tom Cashin, a vice president at Jed Johnson Associates, was too embarrassed and shy, he said, to address the “four eyes” of his therapist and the therapist’s German shepherd. And Shannon Birk remembers choosing a therapist from a list provided by her H.M.O. seven years ago, when she was “smack dab in a major depression.” The doctor’s office contained a dog bed, housebreaking training pads and a small dog. One day, Ms. Birk found herself in the waiting room well past the appointed session time. When the door finally swung open, there was the dog, outfitted in a Halloween devil costume. “The doctor had the little red-horned headband and scissors in her hand,” Ms. Birk remembered, “while she explained the headpiece was too big. Apparently she had been attempting to alter it while she kept me waiting.” During another session, recalled Ms. Birk, the doctor paused to give the dog a biscuit for performing a trick.

SO what do therapists think about when they decorate an office? Ann Maloney, an interior designer turned psychiatrist, works on the ground floor of the Manhattan brownstone where she also lives (the entrances are separate). She knows a thing or two about the semiotics of objects and the meanings that lurk behind décor. Working as a designer in her 20’s, “I realized that when my clients were arguing about the drapes,” she said, “it was never really about the drapes.”

Dr. Maloney continued, “My bent is, the most important thing about your space is that you’re comfortable enough to do your work well, and that it reflect you,” she said. “I don’t mean your inner dark secrets, but something about you as a person. It’s a market, and patients are savvy. Your home and your office are reflections of you. Why would you want to see someone who doesn’t appear to have their act together?”

Though as Christian McLaughlin, a movie producer explained, grotty décor can be therapeutic. “I always had this vision of therapists’ offices as fairly posh and leathery, with degrees on the walls from Ivy League institutions,” said Mr. McLaughlin, 38. In other words, aspirational. But then Mr. McLaughlin, who moved to Los Angeles from New York eight years ago to produce “Legally Blonde,” found himself in therapy for the first time, in a dump of an office in the Valley next to a casting agency.

“The large couch on which I’d sit every week was covered with cheap stuffed animals caked in dried tears and snot,” he recalled. “I never started a therapy session in which I wasn’t physically repulsed by the surroundings, like an animal fearing for its life. Therapy was already so wildly uncomfortable to me, and since the setting was, too, it just all went hand in hand and I had to embrace it.”

Florence Fellman, a movie set decorator, said that when she creates a set for a psychiatrist character, she uses “clichéd objects” so the audience can read the scene immediately, like American Indian baskets and African art and “all kinds of familiar ethnic art that says, ‘I’m accepting of all cultures and customs so anything you say here won’t shock me.’ ” When her son was a teenager, “and needed help coping,” she said, he was referred to a psychiatrist whose office looked like one of Ms. Fellman’s sets come to life. “I tried to suppress my instinct that his advice would be as clichéd as his office.” Four $400 sessions later, her instinct turned out to be right.

The set of “In Treatment” displays none of these clichés. In fact, Weston’s overstuffed office, with its huge boat models, parchment-shaded lamps and books, reads most like the living room of a Harvard academic with a trust fund, or maybe a Kennedy relative. Suzuki Ingerslev, the show’s production designer, dressed it thus not in service to any ideal she carried about a therapist’s office but “to create interest behind the character’s heads. If we had blank walls in there, people would die watching it,” she said.

“It’s like an antique shop,” said Robert Langs, a Manhattan psychoanalyst. “And the bathroom inside it! I think the whole show is chaos, and he’s trying to drive his patients crazy.”

Tchotchkes and plumbing aside, for Dr. Langs, who described himself as a revisionist Freudian with a sparsely furnished office in an office building, “there is only one archetypal unconscious view of a home office. And that is that the home office is totally inappropriate and destructive to the patient. And what about the impact on the therapist’s own family?”

David Tolchinsky, a 45-year-old screenwriter and chair of the Radio, Television and Film department at Northwestern University, has thought a lot about that question. He grew up with an analyst father who saw patients in the family living room. This was closed off by two double doors, and no family member could walk around during sessions or enter or leave the house when patients were doing so. Mr. Tolchinsky admitted it was an oppressive environment, but it was also a boon, he said. One of his screenplays in development, “Reflections on a Teenage Antichrist,” is about a heavy metal loving teenager who slowly begins to believe his psychiatrist father may in fact be the devil. “A lot of the scenes take place in his house, with the teen hero listening at the double doors of his father’s office. O.K., so I don’t think my father was the devil, but he did give me a great gift as a writer, which is the image of those closed double doors.”